Retrospective analysis of data in youth evaluated for attempted suicide

Abstracts: Poster Presentations noted a decrease in appetite and she was afraid that the pain would recur whenever she ate. There was mild nausea with one episode of vomiting. There was no history of change in bowel habits or urinary tract symptoms. The patient was premenarchal and had not noted any vaginal discharge. On exam, she was afebrile and the vital signs were normal. The general physical was entirely unremarkable other than mild tenderness in the right lower quadrant. The rectal was also normal. A pelvic examination was not performed. RESULTS: The following studies were performed at the outlying hospital and found to be normal: complete blood count, serum chemistries, pregnancy test, urinalysis, urine culture and stool culture. A stool sample was slightly positive for occult blood. A plain film of the abdomen showed distended small bowel loops. Markedly thickened loops of small bowel in the right lower abdomen were seen on a CAT scan of the abdomen. The patient was felt to have a ruptured appendix and then transferred to our facility. At surgery, she was found to have torsion of a Meckel diverticulum with adhesive bands to the mesentery and an internal hernia with 20 centimeters of twisted, necrotic small bowel. The involved segment was then resected and the patient had an uneventful recovery. CONCLUSIONS: This paper documents that torsion of a Meckel diverticulum associated with internal herniation and small bowel obstruction may present in adolescent girls with unexplained right lower quadrant pain. Practitioners who provide gynecologic care for teenagers should be aware of this entity as it may simulate a number of pelvic conditions. Early recognition and prompt surgical treatment are essential to an optimal outcome so that any serious complications can be avoided. PII S1083-3188(01)00096-1

RETROSPECTIVE ANALYSIS OF DATA IN YOUTH EVALUATED FOR ATTEMPTED SUICIDE Hatim Omar, MD, Julie Hagedorn, MD, Section of Adolescent Medicine, University of Kentucky, Lexington, KY BACKGROUND: Suicide is the third leading cause of death in adolescents and a major contributor to morbidity in this age group. The objective of this study was to study the demographics, major stressors and factors leading to attempting suicide as well as the methods of attempted suicide in adolescents admitted to two hospitals in a medium size city. METHODS: Medical records review of adolescents admitted to two area hospitals for attempted suicide between 7/1/ 97-12/31/99. Coroner’s data on completed suicide were also reviewed. RESULTS: In the period above a total of 287 patients 21 years of age or under were admitted for attempted suicide. Mean age was 16.9 and age range between 7-21. 53.4% of the total were females and 46.6 were males with the majority of the total being Caucasians (75.6%). Interpersonal conflicts were the most common stressors preceding the attempt; fight with parents 20%, end of a relationship 12%, fight with a significant other 8%. Financial difficulties were the culprit in 10% of the cases. Abuse was not clearly recorded in 64% of cases. In cases where documentation was clear, 60% reported sexual and 67% physical abuse. Nearly

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half of the patients had a prior psychiatric diagnosis with prior suicide attempt and depression being most common at 27 and 18% respectively. Overdose was the most common method utilized. There were 20 completed adolescent suicides in the area with firearms as the method used in all of them. CONCLUSION: Suicide continues to be a major problem in adolescents. Access to guns may be a detrimental factor in completing suicide. Health care providers may help identify those at risk by routinely screening all adolescents for depression and suicide. PII S1083-3188(01)00097-3

IMPROVED CONTINUATION RATE OF DEPO-PROVERA IN TEEN MOTHERS Hatim Omar, MD, Amy Fowler, Sandy D’Angelo, PhD, Section of Adolescent Medicine, University of Kentucky, Lexington, KY BACKGROUND: Poor compliance and high discontinuation rates of Depo-Provera (DP) and other contraceptive methods are major factors in the continuing problem of teen pregnancy. In this study we attempted to determine if providing comprehensive health care for teen mothers and their babies would improve continuation rates of DP. METHODS: Review of clinical data in a Teen-Tot program in regards to DP. Patients who started DP between 1/1/96 and 1/1/99 were included. Teen mothers and their babies receive all their health care in this clinic, supported by State funding. Key elements regarding DP in this clinic are: continuity of care, phone or mail reminders of appointments, free DP for patients without insurance, counseling at each visit and available evening clinic. RESULTS: In the period above a total of 299 (age 13-22) patients were started on DP. 51% were white, 47% black and 2% others. 63% were single, 20% married, 3% cohabitating and 14% undetermined (missing data). 78% had one baby and 22% more than one. A total of 189 patients (63.2%) continued to be compliant after one year of use. 84 patients (28% of total) continued beyond the second year, but the actual percentage of continuation will be higher when patients who are now on DP more than 1 but less than 2 years are included. The most common side effect reported was bleeding/spotting (32%). However only 7 patients (2.3%) discontinued use because of it. CONCLUSION: Continuity of care (same staff and providers on each visit), regular counseling, flexible hours (evening appointments), financial ease (free DP and no visit charge for those without insurance), combined Teen-Tot health visits and regular reminders of appointments help improve compliance and continuation rates in teen mothers leading to better success in prevention of repeat teen pregnancy. PII S1083-3188(01)00098-5 PREMENARCHAL VAGINAL DISCHARGE: FINDINGS OF PROCEDURES TO RULE OUT FOREIGN BODIES Yolanda R Smith, MD, Deborah R Berman, MD, Elisabeth H Quint, MD, University of Michigan Health Systems, Ann Arbor, MI